Geleneksel Çin Tıbbı-Akupunkturun Cerrahi Bakımda Kullanımı
Özet
Akupunktur, cerrahi süreçlerde ağrı yönetimi, anesteziye destek ve ameliyat sonrası iyileşmeyi hızlandıran, farmakolojik olmayan ve bilimsel temellere dayanan bir tamamlayıcı tıp yöntemidir. Günümüzde cerrahi hasta bakımında kanıta dayalı olarak daha yaygın kullanılmakta olup, çeşitli meta-analizler ve klinik çalışmalarla desteklenmektedir Sistematik derlemeler ve meta-analizler, akupunkturun ameliyat sonrası akut ağrı ve opioid tüketimini anlamlı düzeyde azalttığını ortaya koymaktadır. Akupunkturun opioid kaynaklı yan etkilerden özellikle bulantı ve kusmayı azaltırken, ameliyat öncesi anksiyeteyi de hafiflettiği belirlenmiştir. Ayrıca, akupunktur gastrointestinal motiliteyi artırarak, büyük abdominal cerrahiler sonrası önemli bir komplikasyon olan ileusun önlenmesine katkıda bulunmaktadır. Tamamlayıcı bir yaklaşım olarak akupunktur, cerrahi bakımın iyileştirilmesinde çok yönlü faydalar sunmaktadır. Hasta merkezli cerrahi hemşirelik bakımının geliştirilmesindeki rolü, yapılandırılmış eğitim programlarının oluşturulması, disiplinler arası iş birliğinin desteklenmesi ve klinik araştırmaların sürdürülmesi gerekliliğini vurgulamaktadır. Cerrahi hasta bakımının iyileştirilmesi ve kanıta dayalı, bütüncül sağlık hizmetlerinin güçlendirilmesi açısından akupunktur temelli girişimlerin uygulanması ve savunulmasında, uygun yasal düzenlemelerle cerrahi hemşirelerinin aktif rol alması önemlidir.
Acupuncture is a non-pharmacological and scientifically grounded complementary medicine approach that supports pain management, anesthesia, and postoperative recovery in surgical processes. Today, it is increasingly utilized in evidence-based surgical patient care, supported by various meta-analyses and clinical studies. Systematic reviews and meta-analyses have demonstrated that acupuncture significantly reduces postoperative acute pain and opioid consumption. Additionally, it has been shown to alleviate opioid-related side effects, particularly nausea and vomiting, while also mitigating preoperative anxiety. Moreover, acupuncture enhances gastrointestinal motility, contributing to the prevention of ileus, a significant complication following major abdominal surgeries. As a complementary approach, acupuncture offers multifaceted benefits in improving surgical care. Its role in advancing patient-centered surgical nursing care underscores the necessity of developing structured training programs, promoting interdisciplinary collaboration, and sustaining clinical research. In the context of enhancing surgical patient care and strengthening evidence-based, holistic healthcare services, the implementation and advocacy of acupuncture-based interventions, with the active involvement of surgical nurses under appropriate regulatory frameworks, are of critical importance.
Referanslar
Chernyak GV, Sessler DI. Perioperative acupuncture and related techniques. Anesthesiology. 2005;102(5):1031-1049. doi: 10.1097/00000542-200505000-00024.
Lu GD, Needham J. Celestial lancets: A history and rationale of acupuncture and moxa. London: Routledge; 2002.
Kavaklı A. Akupunktur. Fırat Tıp Dergisi. 2010;15(1):1-4.
Zhang R, Lao L, Ren K, et al. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology. 2014;120(2):482-503. doi: 10.1097/ALN.0000000000000101.
Lee IS, Lee H, Chen YH, et al. Bibliometric analysis of research assessing the use of acupuncture for pain treatment over the past 20 years. Journal of Pain Research. 2020;13:367–376. doi: 10.2147/JPR.S235047
He JR, Yu SG, Tang Y, et al. Purinergic signaling as a basis of acupuncture-induced analgesia. Purinergic Signal. 2020;16:297–304. doi: 10.1007/s11302-020-09708-z
Fan Z, Dou B, Wang J, et al. Effects and mechanisms of acupuncture analgesia mediated by afferent nerves in acupoint microenvironments. Frontiers in Neuroscience. 2024; 17: 1239839. doi:10.3389/fnins.2023.1239839
Zhou Y, Bao Q, Yang C, et l. Auricular acupuncture for perioperative pain management: a systematic review and meta-analysis of randomized controlled trials. Journal of Pain Research. 2025:441-454. doi: 10.2147/JPR.S488525
Soliman N, Frank BL. Auricular acupuncture and auricular medicine. Physical Medicine and Rehabilitation Clinics of North America. 1999;10(3):547-554. doi: 10.1016/s1047-9651(18)30180-3.
Lin JG, Kotha P, Chen YH. Understandings of acupuncture application and mechanisms. American Journal of Translatioal Research. 2022;14(3):1469-1481.
de Oliveira Rodrigues DM, Menezes PR, Machado Ribeiro Silotto AE, et al. Efficacy and safety of auricular acupuncture for depression: A Randomized Clinical Trial. JAMA Network Open. 2023;6(11):e2345138. doi:10.1001/jamanetworkopen.2023.45138
Chen Q, HongMei M, Yi L. Acupoint application combined with acupressure as an adjunctive therapy for chemotherapy-induced nausea and vomiting. Journal of Visualized Experiments. 2024;(208):e66865. doi:10.3791/66865
Chen SR, Hou WH, Lai JN, et al. Effects of acupressure on anxiety: a systematic review and meta-analysis. Journal of integrative and complementary medicine. 2022;28(1):25-35. doi.org/10.1089/jicm.2020.0256
Ceyhan, Ö. Akupunktur ve etki mekanizmaları. Türkiye Klinikleri Traditional and Complementary Medicine-Special Topics, 2022; 3(2): 1-5.
Dorsher Peter T, Marco Antonio Helio da Silva. Acupuncture’s neuroanatomic and neurophysiologic basis. Longhua Chinese Medicine. 2022;(5). doi.org/10.21037/lcm-21-21.
Li QQ, Shi GX, Xu Q, et al. Acupuncture effect and central autonomic regulation. Evidence-Based Complementary and Alternative Medicine. 2013;(1): 267959. doi.org/10.1155/2013/267959
Li N, Guo Y, Gong Y, et al. The anti-inflammatory actions and mechanisms of acupuncture from acupoint to target organs via neuro-immune regulation. Journal of Inflammation Research. 2021;14:7191–7224. doi.org/10.2147/JIR.S341581
Cheng KJ. Neurobiological mechanisms of acupuncture for some common illnesses: a clinician’s perspective. Journal of Acupuncture and Meridian Studies. 2014;7(3):105-114. doi.org/10.1016/j.jams.2013.07.008
Değirmen N, Gür S, Kanan, N. Ameliyat sonrası ağrıda tamamlayıcı terapiler. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi. 2022;12(1):55-66.
Türkiş NA, Taşdemir N, Tank DY. Ameliyat sonrası bulantı kusma yönetiminde alternatif ve tamamlayıcı tedavilerin incelenmesi. Yaşam Boyu Hemşirelik Dergisi. 2024;1(1):189-215.
Güven PG. Preoperatif anksiyetenin tedavisinde akupunkturun yeri. Atatürk Üniversitesi Tıp Fakültesi Cerrahi Tıp Bilimleri Dergisi. 2023;2(1):44-46.
Bae H, Bae H, Min BI, et al. Efficacy of acupuncture in reducing preoperative anxiety: a meta‐analysis. Evidence-Based Complementary and Alternative Medicine.2014;(1):1-12. doi.org/10.1155/2014/850367
Pilkington K, Kirkwood G, Rampes H, et al. Acupuncture for anxiety and anxiety disorders–a systematic literature review. Acupuncture in Medicine. 2007;25(1-2):1-10.
Qiu M, Li C, Sun T, et al. Effect of perioperative acupuncture-assisted general anesthesia on the anesthetic dosage required in adult surgical patients: a network meta-analysis of randomized controlled trials. Frontiers in Medicine. 2023;(10):113. doi.org/10.3389/fmed.2023.1133585
Lu Z, Dong H, Wang Q, et al. Perioperative acupuncture modulation: more than anaesthesia. British Journal of Anaesthesia. 2015 Aug;115(2):183–193. doi:10.1093/bja/aev227.
Sun Y, Gan TJ, Dubose JW, et al. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. British Journal of Anaesthesia. 2008 Aug;101(2):151-60. doi: 10.1093/bja/aen146.
Ben-Arye E, Hirsh I, Segev Y, et al. A randomized-controlled trial assessing the effect of intraoperative acupuncture on anesthesia-related parameters during gynecological oncology surgery. Journal of Cancer Research and Clinical Oncology. 2023;149:8177–8189. doi:10.1007/s00432-023-04758-3.
W MS, Chen KH, Chen IF, et al. The efficacy of acupuncture in post‐operative pain management: a systematic review and meta-analysis. PLOS One. 2016;11(3):1-12. doi.org/10.1371/journal.pone.0150367
Liu Y, Huang L, Xu G, et al. The application of acupuncture therapy for postoperative pain over the past 20 years: a bibliometric analysis. Journal of Pain Research. 2022 Jul 27;(15):2085-2104. doi: 10.2147/JPR.S371399
Nielsen JA, Dusek JA, Taylor-Swanson L, et al. Acupuncture therapy as an evidence-based nonpharmacologic strategy for comprehensive acute pain care: The Academic Consortium Pain Task Force White Paper Update. Pain Medicine. 2022 Sep;23(9):1582–1612. doi:10.1093/pm/pnac056.
Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA. 2014;311(9):955–956. doi:10.1001/jama.2013.285478
Holmér Pettersson P, Wengström Y. Acupuncture prior to surgery to minimise postoperative nausea and vomiting: a systematic review. Journal of Clinical Nursing. 2012;21:1799–1805. doi:10.1111/j.1365-2702.2012.04114.x.
Liu Y, Li Y, Liu M, et al. Effects of acupuncture‐point stimulation on perioperative sleep disorders: a systematic review with meta‐analysis and trial sequential analysis. International Journal of Clinical Practice. 2024;1:6763996. doi:10.1155/2024/6763996.
Chen IH, Yeh TP, Yeh YC, et al. Effects of acupressure on sleep quality and psychological distress in nursing home residents: a randomized controlled trial. Journal of the American Medical Directors Association. 2019;20(7):822–829. doi:10.1016/j.jamda.2019.01.003.
Aygin D, Şen S. Acupressure on anxiety and sleep quality after cardiac surgery: a randomized controlled trial. Journal of PeriAnesthesia Nursing. 2019;34(6):1222–1231. doi:10.1016/j.jopan.2019.03.014.
Yeung WF, Chung KF, Zhang SP, et al. Electroacupuncture for primary insomnia: A Randomized Controlled Trial. Sleep. 2009 August;32(8):1039–1047. doi.org/10.1093/sleep/32.8.1039
Andrews S, Dempsey B. Acupressure and reflexology essentials. In: Acupressure & Reflexology For Dummies. 1st ed. Indianapolis, IN: Wiley Publishing, Inc.2007;10–65.
Yanık TC, Altun Uğraş G. Akupresür kullanımının cerrahi girişim sonrası uyku kalitesine etkisi. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi. 2020;2(2):105–112.
Sun JL, Sung MS, Huang MY, et al. Effectiveness of acupressure for residents of long-term care facilities with insomnia: A Randomized Controlled Trial. International Journal of Nursing Studies. 2010;47(7):798–805. doi.org/10.1016/j.ijnurstu.2009.12.003
Yang NN, Yang JW, Ye Y, et al. Electroacupuncture ameliorates intestinal inflammation by activating α7nAChR-mediated JAK2/STAT3 signaling pathway in postoperative ileus. Theranostics. 2021 Feb 19;11(9):4078-4089. doi: 10.7150/thno.52574.
Atalar Ö, Türk G, Yüce A, et al. Diyabet, yara iyileşmesi ve sperm kalitesi üzerine akupunkturun önemi. Fırat Üniversitesi Sağlık Bilimleri Veteriner Dergisi. 2013;27(2):109–113.
Referanslar
Chernyak GV, Sessler DI. Perioperative acupuncture and related techniques. Anesthesiology. 2005;102(5):1031-1049. doi: 10.1097/00000542-200505000-00024.
Lu GD, Needham J. Celestial lancets: A history and rationale of acupuncture and moxa. London: Routledge; 2002.
Kavaklı A. Akupunktur. Fırat Tıp Dergisi. 2010;15(1):1-4.
Zhang R, Lao L, Ren K, et al. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology. 2014;120(2):482-503. doi: 10.1097/ALN.0000000000000101.
Lee IS, Lee H, Chen YH, et al. Bibliometric analysis of research assessing the use of acupuncture for pain treatment over the past 20 years. Journal of Pain Research. 2020;13:367–376. doi: 10.2147/JPR.S235047
He JR, Yu SG, Tang Y, et al. Purinergic signaling as a basis of acupuncture-induced analgesia. Purinergic Signal. 2020;16:297–304. doi: 10.1007/s11302-020-09708-z
Fan Z, Dou B, Wang J, et al. Effects and mechanisms of acupuncture analgesia mediated by afferent nerves in acupoint microenvironments. Frontiers in Neuroscience. 2024; 17: 1239839. doi:10.3389/fnins.2023.1239839
Zhou Y, Bao Q, Yang C, et l. Auricular acupuncture for perioperative pain management: a systematic review and meta-analysis of randomized controlled trials. Journal of Pain Research. 2025:441-454. doi: 10.2147/JPR.S488525
Soliman N, Frank BL. Auricular acupuncture and auricular medicine. Physical Medicine and Rehabilitation Clinics of North America. 1999;10(3):547-554. doi: 10.1016/s1047-9651(18)30180-3.
Lin JG, Kotha P, Chen YH. Understandings of acupuncture application and mechanisms. American Journal of Translatioal Research. 2022;14(3):1469-1481.
de Oliveira Rodrigues DM, Menezes PR, Machado Ribeiro Silotto AE, et al. Efficacy and safety of auricular acupuncture for depression: A Randomized Clinical Trial. JAMA Network Open. 2023;6(11):e2345138. doi:10.1001/jamanetworkopen.2023.45138
Chen Q, HongMei M, Yi L. Acupoint application combined with acupressure as an adjunctive therapy for chemotherapy-induced nausea and vomiting. Journal of Visualized Experiments. 2024;(208):e66865. doi:10.3791/66865
Chen SR, Hou WH, Lai JN, et al. Effects of acupressure on anxiety: a systematic review and meta-analysis. Journal of integrative and complementary medicine. 2022;28(1):25-35. doi.org/10.1089/jicm.2020.0256
Ceyhan, Ö. Akupunktur ve etki mekanizmaları. Türkiye Klinikleri Traditional and Complementary Medicine-Special Topics, 2022; 3(2): 1-5.
Dorsher Peter T, Marco Antonio Helio da Silva. Acupuncture’s neuroanatomic and neurophysiologic basis. Longhua Chinese Medicine. 2022;(5). doi.org/10.21037/lcm-21-21.
Li QQ, Shi GX, Xu Q, et al. Acupuncture effect and central autonomic regulation. Evidence-Based Complementary and Alternative Medicine. 2013;(1): 267959. doi.org/10.1155/2013/267959
Li N, Guo Y, Gong Y, et al. The anti-inflammatory actions and mechanisms of acupuncture from acupoint to target organs via neuro-immune regulation. Journal of Inflammation Research. 2021;14:7191–7224. doi.org/10.2147/JIR.S341581
Cheng KJ. Neurobiological mechanisms of acupuncture for some common illnesses: a clinician’s perspective. Journal of Acupuncture and Meridian Studies. 2014;7(3):105-114. doi.org/10.1016/j.jams.2013.07.008
Değirmen N, Gür S, Kanan, N. Ameliyat sonrası ağrıda tamamlayıcı terapiler. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi. 2022;12(1):55-66.
Türkiş NA, Taşdemir N, Tank DY. Ameliyat sonrası bulantı kusma yönetiminde alternatif ve tamamlayıcı tedavilerin incelenmesi. Yaşam Boyu Hemşirelik Dergisi. 2024;1(1):189-215.
Güven PG. Preoperatif anksiyetenin tedavisinde akupunkturun yeri. Atatürk Üniversitesi Tıp Fakültesi Cerrahi Tıp Bilimleri Dergisi. 2023;2(1):44-46.
Bae H, Bae H, Min BI, et al. Efficacy of acupuncture in reducing preoperative anxiety: a meta‐analysis. Evidence-Based Complementary and Alternative Medicine.2014;(1):1-12. doi.org/10.1155/2014/850367
Pilkington K, Kirkwood G, Rampes H, et al. Acupuncture for anxiety and anxiety disorders–a systematic literature review. Acupuncture in Medicine. 2007;25(1-2):1-10.
Qiu M, Li C, Sun T, et al. Effect of perioperative acupuncture-assisted general anesthesia on the anesthetic dosage required in adult surgical patients: a network meta-analysis of randomized controlled trials. Frontiers in Medicine. 2023;(10):113. doi.org/10.3389/fmed.2023.1133585
Lu Z, Dong H, Wang Q, et al. Perioperative acupuncture modulation: more than anaesthesia. British Journal of Anaesthesia. 2015 Aug;115(2):183–193. doi:10.1093/bja/aev227.
Sun Y, Gan TJ, Dubose JW, et al. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. British Journal of Anaesthesia. 2008 Aug;101(2):151-60. doi: 10.1093/bja/aen146.
Ben-Arye E, Hirsh I, Segev Y, et al. A randomized-controlled trial assessing the effect of intraoperative acupuncture on anesthesia-related parameters during gynecological oncology surgery. Journal of Cancer Research and Clinical Oncology. 2023;149:8177–8189. doi:10.1007/s00432-023-04758-3.
W MS, Chen KH, Chen IF, et al. The efficacy of acupuncture in post‐operative pain management: a systematic review and meta-analysis. PLOS One. 2016;11(3):1-12. doi.org/10.1371/journal.pone.0150367
Liu Y, Huang L, Xu G, et al. The application of acupuncture therapy for postoperative pain over the past 20 years: a bibliometric analysis. Journal of Pain Research. 2022 Jul 27;(15):2085-2104. doi: 10.2147/JPR.S371399
Nielsen JA, Dusek JA, Taylor-Swanson L, et al. Acupuncture therapy as an evidence-based nonpharmacologic strategy for comprehensive acute pain care: The Academic Consortium Pain Task Force White Paper Update. Pain Medicine. 2022 Sep;23(9):1582–1612. doi:10.1093/pm/pnac056.
Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA. 2014;311(9):955–956. doi:10.1001/jama.2013.285478
Holmér Pettersson P, Wengström Y. Acupuncture prior to surgery to minimise postoperative nausea and vomiting: a systematic review. Journal of Clinical Nursing. 2012;21:1799–1805. doi:10.1111/j.1365-2702.2012.04114.x.
Liu Y, Li Y, Liu M, et al. Effects of acupuncture‐point stimulation on perioperative sleep disorders: a systematic review with meta‐analysis and trial sequential analysis. International Journal of Clinical Practice. 2024;1:6763996. doi:10.1155/2024/6763996.
Chen IH, Yeh TP, Yeh YC, et al. Effects of acupressure on sleep quality and psychological distress in nursing home residents: a randomized controlled trial. Journal of the American Medical Directors Association. 2019;20(7):822–829. doi:10.1016/j.jamda.2019.01.003.
Aygin D, Şen S. Acupressure on anxiety and sleep quality after cardiac surgery: a randomized controlled trial. Journal of PeriAnesthesia Nursing. 2019;34(6):1222–1231. doi:10.1016/j.jopan.2019.03.014.
Yeung WF, Chung KF, Zhang SP, et al. Electroacupuncture for primary insomnia: A Randomized Controlled Trial. Sleep. 2009 August;32(8):1039–1047. doi.org/10.1093/sleep/32.8.1039
Andrews S, Dempsey B. Acupressure and reflexology essentials. In: Acupressure & Reflexology For Dummies. 1st ed. Indianapolis, IN: Wiley Publishing, Inc.2007;10–65.
Yanık TC, Altun Uğraş G. Akupresür kullanımının cerrahi girişim sonrası uyku kalitesine etkisi. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi. 2020;2(2):105–112.
Sun JL, Sung MS, Huang MY, et al. Effectiveness of acupressure for residents of long-term care facilities with insomnia: A Randomized Controlled Trial. International Journal of Nursing Studies. 2010;47(7):798–805. doi.org/10.1016/j.ijnurstu.2009.12.003
Yang NN, Yang JW, Ye Y, et al. Electroacupuncture ameliorates intestinal inflammation by activating α7nAChR-mediated JAK2/STAT3 signaling pathway in postoperative ileus. Theranostics. 2021 Feb 19;11(9):4078-4089. doi: 10.7150/thno.52574.
Atalar Ö, Türk G, Yüce A, et al. Diyabet, yara iyileşmesi ve sperm kalitesi üzerine akupunkturun önemi. Fırat Üniversitesi Sağlık Bilimleri Veteriner Dergisi. 2013;27(2):109–113.
